Canada-Ontario Affordable Housing Program

HOUSING ALLOWANCE/RENT SUPPLEMENT PROGRAM APPLICATION FORM

Personal information is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M.56 (“MFOIPPA”); the Housing Development Act, R.S.O. 1990, c. H.18 (“HDA”); the Ministry of Municipal Affairs and Housing Act, R.S.O. 1990, c. M.30 (“MMAHA”); the Ontario Housing Corporation Act, R.S.O. 1990, c. O.21 (“OHCA”); and the Personal Information Protection and Electronic Documents Act, S.C. 2000, c. 5 (“PIPEDA”). The personal information will be used to determine the suitability of rental units offered by owners. Personal information may be disclosed to Local Housing Corporations, the Ministry of Municipal Affairs and other municipal/provincial and federal departments and agencies (collectively “third parties”) who assist in the provision of affordable housing.
The Owner and/or Managing Agent represent and warrant that: (a) he/they shall preserve the PIPEDA compliance of all PIPEDA protected information transferred to him/them by third parties; (b) he/they shall ensure the PIPEDA compliance of all PIPEDA protected information collected by him/them in the course of performing his/their contractual obligations; and (c) he/they shall ensure the PIPEDA compliance of all PIPEDA protected information that he/they transfer to third parties.
Questions about the collection and disclosure of personal information should be directed to the Local Municipal Service Manager.

To be completed by Owner or Managing Agent

Name / Telephone No.
Address / Municipality / Cheques Payable to:
Managing Agent
Name / Telephone No.
Address / Municipality / Cheques Payable to:
Building Location
Address / Municipality
Building Information
Contact for Building Inspection / Telephone No.
Agreement
Owner / Term of Initial Agreement (Years) / Effective Date
Specify Building Type
Single/Detached / Apartment (walk up) /

Duplex

/ Triplex
Semi-detached / Apartment (elevator) / Row Housing / Row Housing/Stacked
Government Program Built Under / Number of Stories / Year Built / Total Number of Units in Building
Units Available / Floor Area (Sq. ft.) / Number of Units Offered / Monthly Rent
Regular / Modified
Bachelor/Studio
1-Bedroom
2-Bedroom
3-Bedroom
4-Bedroom
Please specify if the following are included as part of rent. / Included / Not Included / Additional Charges
Heating (Method):
Hot Water
Water
Hydro
Refrigerator
Stove
Washer/Dryer / $
Television Service / Master Antenna / $
Cable T.V. / $

Parking

/ Indoor / $
Outdoor / $
Other (Specify) / $
I hereby certify that the above information is correct and the rents are in accordance with the Tenant Protection Act, 1997, S.O. 1997, c. 24 / Authorized Signature and Title: / Date:

To be completed by Service Manager

BUILDING DESCRIPTION AND CONDITIONS
Exterior
Parking Facilities
Landscaping
Structural
Mechanical
Janitorial Services
Elevators
Tenant Restrictions
COMMUNITY SERVICES
Schools
Houses of Worship
Day Care
Transportation
Recreational Facilities
Nearest Main Intersection
Other
GENERAL
Unit - Special Features:
Project - Special Features:
Outstanding Work Orders from Municipality:
General Comments:
Recommendations:
Units Approved:
Proposed Term of Agreement: / Completion Date: / Occupancy Date:
Inspected by: / Date:


Housing Allowance/Rent Supplement Program Guidelines